A definition of “flare” in low back pain: a multiphase process involving perspectives of individuals with low back pain and expert consensus

Nathalia Costa, Manuela L. Ferreira, Jenny Setchell, Joanna Makovey, Tanya Dekroo, Aron Downie, Ashish Diwan, Bart Koes, Bard Natvig, Bill Vicenzino, David Hunter, Eric J. Roseen, Eva Rasmussen-Barr, Francis Guillemin, Jan Hartvigsen, Kim Bennell, Leonardo Costa, Luciana Macedo, Marina Pinheiro, Martin Underwood & 8 others Mauritus Van Tulder, Melker Johansson, Paul Enthoven, Peter Kent, Peter O'Sullivan, Pradeep Suri, Stephane Genevay, Paul W. Hodges

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Low back pain (LBP)varies over time. Consumers, clinicians, and researchers use various terms to describe LBP fluctuations, such as episodes, recurrences and flares. Although “flare” is use commonly, there is no consensus on how it is defined. This study aimed to obtain consensus for a LBP flare definition using a mixed-method approach. Step 1 involved the derivation of a preliminary candidate flare definition based on thematic analysis of views of 130 consumers in consultation with an expert consumer writer. In step 2, a workshop was conducted to incorporate perspectives of 19 LBP experts into the preliminary flare definition, which resulted in 2 alternative LBP flare definitions. Step 3 refined the definition using a 2-round Delphi consensus with 50 experts in musculoskeletal conditions. The definition favored by experts was further tested with 16 individuals with LBP in step 4, using the definition in three scenarios. This multiphase study produced a definition of LBP flare that distinguishes it from other LBP fluctuations, represents consumers’ views, involves expert consensus, and is understandable by consumers in clinical and research contexts: “A flare-up is a worsening of your condition that lasts from hours to weeks that is difficult to tolerate and generally impacts your usual activities and/or emotions.” Perspective: A multiphase process, incorporating consumers’ views and expert consensus, produced a definition of LBP flare that distinguishes it from other LBP fluctuations.

LanguageEnglish
JournalJournal of Pain
DOIs
Publication statusE-pub ahead of print - 21 Mar 2019

Fingerprint

Low Back Pain
Consensus
Emotions
Referral and Consultation
Research Personnel
Education
Recurrence

Keywords

  • Low back pain
  • flare
  • flare-up
  • definition
  • consensus

Cite this

Costa, Nathalia ; Ferreira, Manuela L. ; Setchell, Jenny ; Makovey, Joanna ; Dekroo, Tanya ; Downie, Aron ; Diwan, Ashish ; Koes, Bart ; Natvig, Bard ; Vicenzino, Bill ; Hunter, David ; Roseen, Eric J. ; Rasmussen-Barr, Eva ; Guillemin, Francis ; Hartvigsen, Jan ; Bennell, Kim ; Costa, Leonardo ; Macedo, Luciana ; Pinheiro, Marina ; Underwood, Martin ; Van Tulder, Mauritus ; Johansson, Melker ; Enthoven, Paul ; Kent, Peter ; O'Sullivan, Peter ; Suri, Pradeep ; Genevay, Stephane ; Hodges, Paul W. / A definition of “flare” in low back pain : a multiphase process involving perspectives of individuals with low back pain and expert consensus. In: Journal of Pain. 2019.
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abstract = "Low back pain (LBP)varies over time. Consumers, clinicians, and researchers use various terms to describe LBP fluctuations, such as episodes, recurrences and flares. Although “flare” is use commonly, there is no consensus on how it is defined. This study aimed to obtain consensus for a LBP flare definition using a mixed-method approach. Step 1 involved the derivation of a preliminary candidate flare definition based on thematic analysis of views of 130 consumers in consultation with an expert consumer writer. In step 2, a workshop was conducted to incorporate perspectives of 19 LBP experts into the preliminary flare definition, which resulted in 2 alternative LBP flare definitions. Step 3 refined the definition using a 2-round Delphi consensus with 50 experts in musculoskeletal conditions. The definition favored by experts was further tested with 16 individuals with LBP in step 4, using the definition in three scenarios. This multiphase study produced a definition of LBP flare that distinguishes it from other LBP fluctuations, represents consumers’ views, involves expert consensus, and is understandable by consumers in clinical and research contexts: “A flare-up is a worsening of your condition that lasts from hours to weeks that is difficult to tolerate and generally impacts your usual activities and/or emotions.” Perspective: A multiphase process, incorporating consumers’ views and expert consensus, produced a definition of LBP flare that distinguishes it from other LBP fluctuations.",
keywords = "Low back pain, flare, flare-up, definition, consensus",
author = "Nathalia Costa and Ferreira, {Manuela L.} and Jenny Setchell and Joanna Makovey and Tanya Dekroo and Aron Downie and Ashish Diwan and Bart Koes and Bard Natvig and Bill Vicenzino and David Hunter and Roseen, {Eric J.} and Eva Rasmussen-Barr and Francis Guillemin and Jan Hartvigsen and Kim Bennell and Leonardo Costa and Luciana Macedo and Marina Pinheiro and Martin Underwood and {Van Tulder}, Mauritus and Melker Johansson and Paul Enthoven and Peter Kent and Peter O'Sullivan and Pradeep Suri and Stephane Genevay and Hodges, {Paul W.}",
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Costa, N, Ferreira, ML, Setchell, J, Makovey, J, Dekroo, T, Downie, A, Diwan, A, Koes, B, Natvig, B, Vicenzino, B, Hunter, D, Roseen, EJ, Rasmussen-Barr, E, Guillemin, F, Hartvigsen, J, Bennell, K, Costa, L, Macedo, L, Pinheiro, M, Underwood, M, Van Tulder, M, Johansson, M, Enthoven, P, Kent, P, O'Sullivan, P, Suri, P, Genevay, S & Hodges, PW 2019, 'A definition of “flare” in low back pain: a multiphase process involving perspectives of individuals with low back pain and expert consensus' Journal of Pain. https://doi.org/10.1016/j.jpain.2019.03.009

A definition of “flare” in low back pain : a multiphase process involving perspectives of individuals with low back pain and expert consensus. / Costa, Nathalia; Ferreira, Manuela L.; Setchell, Jenny; Makovey, Joanna; Dekroo, Tanya; Downie, Aron; Diwan, Ashish; Koes, Bart; Natvig, Bard; Vicenzino, Bill; Hunter, David; Roseen, Eric J.; Rasmussen-Barr, Eva; Guillemin, Francis; Hartvigsen, Jan; Bennell, Kim; Costa, Leonardo; Macedo, Luciana; Pinheiro, Marina; Underwood, Martin; Van Tulder, Mauritus; Johansson, Melker; Enthoven, Paul; Kent, Peter; O'Sullivan, Peter; Suri, Pradeep; Genevay, Stephane; Hodges, Paul W.

In: Journal of Pain, 21.03.2019.

Research output: Contribution to journalArticleResearchpeer-review

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AU - Costa,Nathalia

AU - Ferreira,Manuela L.

AU - Setchell,Jenny

AU - Makovey,Joanna

AU - Dekroo,Tanya

AU - Downie,Aron

AU - Diwan,Ashish

AU - Koes,Bart

AU - Natvig,Bard

AU - Vicenzino,Bill

AU - Hunter,David

AU - Roseen,Eric J.

AU - Rasmussen-Barr,Eva

AU - Guillemin,Francis

AU - Hartvigsen,Jan

AU - Bennell,Kim

AU - Costa,Leonardo

AU - Macedo,Luciana

AU - Pinheiro,Marina

AU - Underwood,Martin

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AU - Enthoven,Paul

AU - Kent,Peter

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AU - Hodges,Paul W.

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